PASSAGEWAY AND THE HEALTH CENTER DOMESTIC VIOLENCE INITIATIVE
In 1997, Brigham and Women's Hospital (BWH) launched Passageway, a domestic violence intervention program developed by the CCHHE. A hospital-wide domestic violence advisory committee articulated the following goal for the program: to develop and support coordinated, safe domestic violence interventions within BWH and in the community. The program model is based on an empowerment philosophy and rooted in the grassroots history of the battered women's movement. In developing Passageway, the CCHHE created a program that would both incorporate the perspectives and experiences of women and assist the hospital in integrating screening for abuse and domestic violence interventions into routine health care.
Since its inception, Passageway has responded to more than 1500 new requests for advocacy services and consultation and trained over 2,000 health care providers and staff. In addition to working with on-going clients, Passageway provides support groups in English and Spanish. Passageway at BWH works collaboratively with community health centers and agencies through its four program components:
- Advocacy Services and Consultation
- Training/Education
- Community Linkages
- Evaluation
Advocacy Services and Consultation
Passageway provides free, voluntary, and confidential services to patients and employees who are experiencing domestic violence. Services include risk assessment and safety planning, crisis intervention, individual counseling, support groups, referrals, intervention with complex systems (e.g., health care, courts, employers), assistance in accessing resources and education to patients and employees in understanding their rights and options. Staff offer consultation to health care providers and hospital staff regarding screening practices, safety planning, and other issues impacting patient and employee safety. Passageway Advocates are available 8:30-5:00 PM, Monday - Friday through the BWH page operater at 617-732-6660. After hours & weekends, page the social worker on call.
Training/Education
Health care providers and staff are trained to understand the issue of domestic violence, how it relates to health care and its impact on women's health and access to health care. Training in prioritized clinical departments is preceded by comprehensive protocol development with the goal of universal screening of female patients. Passageway provides training sessions and technical assistance on safe screening practices and domestic violence interventions. Disguised case vignettes of women's experiences are presented in training sessions to illustrate the impact of domestic violence on women's health. Brigham and Women's Hospital has an institution-wide Domestic Abuse Protocol developed by Passageway and serves as the basic content for clinical training. Pocketsize screening and intervention cards are available to providers. The hospital's Nursing Department has adopted a self-learning packet developed by Passageway that is included in mandatory competencies for all nursing staff.
Community Linkages
Recognizing that the hospital's response is only a part of the larger continuum of domestic violence services, Passageway staff develop and strengthen collaborative relationships with a variety of agencies and institutions, such as sexual assault programs, shelters, police, courts, and state-certified batterer intervention programs. Staff participate in projects that help facilitate smoother referrals and coordination of services between the hospital and community agencies. Listening to the obstacles that women face in accessing community services, advocates inform program priorities in community linkage projects. Current community linkages include:
- Greater Boston Legal Services - a collaborative with funding from the Department of Justice to provide legal assistance to low-income women experiencing domestic violence
- SAGE Boston - a collaboration of over 40 Boston health care, elder protective service and community-based agencies and programs working together to address the needs of women over 60 who have traditionally been under-served by domestic violence and sexual assault services
- NASW Committee on Domestic Violence and Sexual Assault - working group to improve the responses by mental health providers to abused women and perpetrators of domestic violence.
Evaluation
To develop effective advocacy, training, and community linkages, staff conduct quality improvement projects and extensive evaluation to assess needs and determine program priorities. Evaluation projects inform service delivery, protocol development, training content, and community partnerships. In addition to review of service utilization, current evaluation activities include analyzing results of 30 in-depth interviews with abused women, standardizing data collection throughout the hospital and health centers and conducting a review of screening rates in the hospital's Emergency Department. Passageway is working to develop an assessment tool to better measure outcomes in hospital-based domestic violence programs.
Health Center Domestic Violence Initiative
Established in 1999, the Health Center Domestic Violence Initiative is a collaborative between Brookside, Whittier Street and Martha Eliot health centers. Each health center has a full-time advocate supported by community benefits and administered through Passageway. A grant from the Boston Foundation provided one year of funding to develop a coordinated approach to the health centers' and hospital's responses to domestic violence. Currently, advocates from the health centers and Passageway meet quarterly to improve communication and continuity of care for patients and participate in resource sharing and trainings. The Initiative's aim is to ensure consistent and safe domestic violence interventions across the health care system and increase access to support for women experiencing domestic violence. For more information on Passageway, contact Tina Nappi, Program Director, 617-732-5009.
PERINATAL CASE MANAGER PROGRAM
Established in 1991 as a response to the high infant mortality and low birth weight rates in certain Boston neighborhoods, the Perinatal Case Manager Program (PCMP) seeks to prevent infant deaths and poor birth outcomes by addressing the social and medical needs of pregnant women. Case managers at each of six of the hospital's licensed or affiliated health centers in the neighborhoods of Jamaica Plain, Roxbury and the South End provide women with comprehensive support services to complement their clinical care. By working collaboratively with hospital providers, case managers ensure that culturally responsive care continues for pregnant women through their perinatal period.
RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH (REACH 2010)
CCHHE is a principal collaborator with the Boston Public Health Commission and several other partners to identify ways to address the higher death rates from breast and cervical cancer among black women in Boston. The goal of REACH Boston 2010 is to work with the community of black women in Boston to address disparities in breast and cervical cancer screening and treatment. A coalition of providers, public health experts, academicians, community activits, churches, and consumers developed a four-year community action plan that provides public education, trains providers about racial disparities and the unique concerns of black women in regard to the prevention, screening, diagnosis, and treatment of breast and cervical cancer, develops models of care for women, and implements strategies for tracking women in the health care system to unsure adequate follow-up.
HARVARD MEDICAL SCHOOL'S CENTER OF EXCELLENCE IN WOMEN'S HEALTH
Harvard Medical School’s Center of Excellence (CoE) in Women’s Health forges collaboration between women’s health experts based at the medical school’s affiliated hospitals. Topic areas include women’s health research, medical training, clinical care, public health education, community outreach, and the promotion of women in health professions. The CoE has developed an overarching focus to examine and improve the health of minority women. The CCHHE has taken the lead in developing programs and initiatives to address these issues in the CoE. Efforts include developing strategies for improving providers' knowledge about the health care needs of minority and disadvantaged women, improving researchers' understanding of barriers to minority women's participation in research, and developing tools to increase minority women's ability to advocate for services on their own behalf.
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